Doctors on the covid19 frontline

Doctors dealing with covid19 patients seem to be more concerned about transmitting the virus to their families than about contracting it themselves.

In fact, they are so concerned that some have taken the precaution of moving out and temporarily renting apartments rather than going home after work.

Despite the risks, they feel compelled to serve the people of TT and help in any way they can during this difficult and stressful time.

Caura Hospital was being used as a secondary response facility, and Couva the tertiary. Patients in secondary care were those whose symptoms were mild but they still needed to be quarantined, while patients in tertiary care were those who were very sick or needed to be in the Intensive Care Unit (ICU).

As of 4 pm on Saturday, TT had 103 confirmed cases.

During an earlier press conference at 10 am, when the number was 101, Chief Medical Officer Dr Roshan Parasram said one patient was ventilated at the Scarborough General Hospital, 26 were in Caura “in a good state,” and 66 were at Couva. He said of that 66, two were in ICU, one was ventilated, 11 were in the high-dependency unit, and 53 were up and about. He added that one patient was admitted late the night before which accounted for the discrepancy in the numbers.

A young doctor who has been working at the Couva Hospital said she volunteered to work with patients in serious condition. She said in addition to the 100 unemployed or new doctors hired to work directly with covid19 patients, several doctors from anaesthetic, internal medicine, surgery, ICU, and thoracic medicine and other hospital departments volunteered to help.

“I felt this is why we became doctors, and we are needed now to help with the situation. So I’m happy to do what I can.” She said the first batch of medical professionals asked to volunteer were people who lived alone, not with older relatives, and who were medically fit.

Initially she had an area of self-quarantine in her home in case she contracted covid19, but when she saw what was happening around the world and decided to volunteer, she arranged to find a separate apartment so as not to give it to her family, just in case. She added that her family was sad about her decision and her parents missed her, but they were proud of her and her contribution. She speaks to them on the phone every day and sees them from a distance when they pass outside her apartment.

She said she felt safe and comfortable dealing with the patients, because all the medical professionals had proper personal protective equipment (PPE), some of which was better than in some hospitals in the US and the UK.

“But Couva is not a functional hospital,” she explained. “So there were a lot of issues with trying to make things work. It’s an area to house patients, so we don’t have everything up and running. For example, it doesn’t have a laboratory or a pharmacy, so a lot of things had to be brought from Eric Williams (Medical Sciences Complex) for the patients…

“However, it’s still a better idea to house patients there, as opposed to the general hospitals, where they would be putting already sick patients at risk for getting this disease.”

She admitted that the work was stressful because there was a risk of getting the infection, but said that was always a risk for medical practitioners. It was just that covid19 was more contagious and not much was known about it.

She also worked a 24-hour shift of three doctors, with three days off, for two weeks. Thereafter, doctors were rotated so as to limit exposure of the staff to the virus, as well as to get them back to their regular jobs.

Missing time with family, colleagues

The most difficult aspect of working at Couva, she said, was being away from her family and regular colleagues. She had it easier than others, as she was not married, nor did she have children. Some doctors and nurses had not heard from their relatives in weeks and were getting sad or depressed over the lack of human interaction.

“It is quite common for people in the medical fraternity to suffer from mental health issues due to stresses in the workplace, so this could exacerbate those issues.”

She said it was worse for the patients, who were away from their relatives for an extended period, especially those who were still quarantined after a cruise of the Caribbean Sea.

Sixty-eight returned via a chartered flight from Guadeloupe on March 17 and three others returned separately. Of that group of 71, 49 tested positive. She said they had not seen family members in over a month, as they were first on the cruise and are now in quarantine.

“They are surrounded by strangers, and there is a lot of fear. Sometimes I think about what it must be like for them. If it is I contract covid19, I’ll be in the same position in the hospital, not being able to leave until the doctors are sure they are negative, because they could possibly infect others. They actually have to be there by law, so they have had some of their rights taken away in a sense, even if they are not very ill.”

The Quarantine Act states that people suffering, or suspected to be suffering, from an infectious disease could be placed in “isolation.” That meant they could be removed to a hospital or other suitable place approved by the health officer, until they were free from infection or be discharged without undue danger to public health. If someone refuses to follow instructions they could be fined $6,000 and imprisoned for six months.

One necessary measure for the doctor was the PPE (personal protective equipment). It included plastic shoe covers, double gloves, protective suits, face masks, N95 masks, head covers, and goggles, and took about 15 minutes to put on. But there were many patients to one doctor, so it was important to be careful with safety. “I really hope people take heed of the government warnings and take this stay-indoors policy seriously so things could settle down. And those already with the infection would be contained so that it does not spread to more people, because it would be disastrous I really don’t want us to reach the stage of the US and Italy.”

As of Saturday at noon, in Italy there were 124,632 confirmed cases and 15,362 deaths, and in the US there were 290,055 cases and 7,810. Their health systems were overwhelmed and medical professionals were running out of PPE. She added that thus far, TT was doing better than some first world countries but only time would tell if that would change.

Being of service in Caura

A doctor at Caura had a similar experience.

He too volunteered to be on the covid19 team and moved out of his family home to rent an apartment because he was worried about transferring the virus to his family.

He said to put it mildly, his family did not agree with his decision to volunteer. They were very worried about him interacting with suspected and positive patients and any possible exposure. However, he said he was not worried about himself. And that was not because he was young, because there were relatively young people who had the virus, although most were asymptomatic. He was not worried because the medical professionals had proper PPE available to them.

He said nurses often helped doctors put on and take off the PPE as well as double-check that it’s on properly to minimise the exposure to contamination.

They also took proper measures to prevent infection, which included washing their hands. But most importantly, he said, it was a global emergency and not something from which he could shy away.

And so, he worked a 12-hour shift with 24 hours off, with one doctor and several nurses per shift for a week to cover three wards. During that time they dealt with suspected as well as confirmed patients who were stable. He said dealing with admissions of suspected patients and discharge of those who were cleared of having the virus was the busiest time for them. They then had a week off before returning to their normal duties at the hospital they came from.

“We get a week off because going right back out to work could be a bit much. You have to pay attention to burnout, and being overworked can lower your immune system and make you more susceptible to infections. This way, you get to relax and recharge before going back to your normal duties.

“But really the most difficult thing is having the PPE on for so long. It’s really hot under there and you feel like you’re stifling.” He made this comment even after some patients have complained that it was too cold. However, Health Minister Terrence Deyalsingh explained that the low temperature was necessary for the doctor and nurses in their PPE.

Despite these discomforts, the doctor said it was important to adapt and keep a steady focus.

He said whatever the condition of the patients, the doctors and nurses had to do their jobs, make them comfortable, and if a patient deteriorated, keep a clear head to care properly for them. If patients became unstable, they would be transferred to Couva.

“You need to have emotions to empathise with your patients and actually care about them, but not to an extent that it clouds your judgement and your ability to think clinically to take care of the patient.”

His biggest concern, though, was for the country as a whole. He worried that the numbers of suspected cases admitted to hospital would overwhelm the health system.

“The main reason they want people to stay home is to flatten the curve.

“It has already started where we have a lot of admissions for people who we think might have covid. It’s not just hard on the covid team, but hard on hospitals in general, especially the emergency and respiratory teams at Mt Hope.”

He expressed concern that the public health system would not have enough space for patients or enough doctors to care for them if people continue going about “business as usual,” and urged people to stay at home.